Conflict Resolution

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Conflict Resolution

• David Thompson, DNSc, MS, RN
• Jill Marsteller, PhD, MPP

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What is Conflict?

• Perception of mutual interference
• A process that begins when goals of one party are
  frustrated by another
• Requires interdependence/interaction

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Views of Conflict

• Conflict Good (interactionist view) G
• Conflict Natural (human relations view) N
• Conflict Bad (traditional view) B
• Conflict must be managed

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Sources of Conflict

• Conflict arises from resource scarcity
• Goals of parties are incompatible
• Other structural factors (size, routinization,
  specialization, reward systems)
• Conflicting perceptions, ideas, or beliefs
• Differences between people
• Conflicting thoughts/needs within an individual
• Lack of communication (maybe)

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Types of Conflict

• Task Content conflict (differing opinions
  related to the task) G
• Emotional or Relationship conflict
  (interpersonal conflict--dislike, negative
  emotions) B
• Administrative or Process conflict (disagreement
  on how to get the task completede.g., duties,
  decision-making technique) B to N

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Goal of Conflict Resolution

• Confront problems, communicate openly and
  respectfully with someone of opposing opinion to
  provide optimal patient care.

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Why address Conflict Resolution?

• Inevitable in dynamic environments
• Conflict can lead to feelings of powerlessness
• Conflict can cause anyone especially subordinates
  to view administrators, attending physicians as
  adversaries and creates conflict and divided
  loyalties in the workplace

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Assertion IS

• Being appropriately assertive means
• Organized in thought and communication
• Technically and socially competent
• Disavowing perfection while looking for
  clarification / common understanding
• Being owned by the entire team (this is not just
  a subordinate skill-set, and it must be valued
  by the receiver to work)

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Assertion Is NOT

• NOT
• Aggressive
• Hostile
• Confrontational
• Ambiguous
• Demeaning
• Condescending

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The Assertion Model

• Model to guide and improve assertion in the
  interest of patient safety

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Helpful Hints in ApplyingThe Assertion Model

• Focus on the common goal quality care, the
  welfare of the patient, safety its hard to
  disagree with safe, high quality care
• Avoid the issue of whos right and whos wrong
  Patient Centered care concentrate on doing the
  right thing
• De-personalize the conversation
• Actively avoid being perceived as judgmental
• Be hard on the problem, not the people

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Strategies for Conflict Resolution

1. Withdrawallittle or no significance to either
   party (lose-lose)
2. Forcingforce outcome regardless of the desire of
   one party (win-lose)
3. Conciliationgiving in to preserve relationship
   with other party (lose-win)
4. Compromiseconcerned with both outcome and
   relationship (?-?)
5. CONFRONTATIONmeet the problem head on (win-win)

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Confrontation is an Assertive means ofConflict
Resolution

• Respectful negotiation
• Effective Conflict resolution is what is right
  not who is right.
• Never Aggressive. Use to explain perspectives. If
  handled appropriately may be an opportunity to
  educate the other party involved.

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Two Attempt Rule

• Using the elements of assertion make 2 attempts
  to reach a common goal.
• If your viewpoint is disregarded, Traditionally
  continue up the chain of command or escalate to
  achieve resolution.
• Charge nurse
• Nurse Manager
• Fellow
• Attending

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Conservative Response

• Non-confrontational method to gain agreement
  among 2 or more team members
• Used to ensure disagreement does not escalate to
  confrontation by seeking input and advice from
  another team member or outside consultant

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DESC Script

• What is it?
• A structured, assertive, communication approach
  for managing and resolving conflict.
• D Describe the specific situation
• E Express your concerns about the action
• S Suggest other alternatives
• C Consequences should be stated
• Ultimately, consensus shall be reached.
• When to use it?
• Whenever you have a personal conflict with
  another health team member that threatens your
  ability to perform your job well
• Key Points
• Have timely discussion

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DESC Example

• D- When you scream at me in front of my
  co-workers about the delay in care, youre making
  it personal.
• E- This reduces my credibility with the patients
  and undermines my authority with staff. I feel
  you dont respect me.
• S- If you are upset about delays or other patient
  care issues, pull me aside and I will address
  your concerns.
• C- If your outbursts continue we wont have a
  working relationship, and patient care will
  suffer.

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LEEN--A Model for Conflict Resolution

• L- Listen
• E- Empathize
• E- Explain
• N- Negotiate

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Conflict with Patients/Families

• L- Can you help me understand why you are upset.
  
• E- That is understandable, I can see why you
  are upset.
• E- The reason we wanted to do this was because
• N- Lets agree on a path forward.

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Conflict with Clinicians

• L- Can you help me understand how you see the
  situation, how you are weighing the risks and
  benefits.
• E- I can see how you see it that way.
• E- Let me explain how I see things.
• N- Lets put the patient first and agree on a
  plan.